The Role of Surgery in the Palliative Care of Cancer: A Retrospective Analysis of 22 years
Journal Title: Journal of Clinical Medical Research - Year 4, Vol 1, Issue 1
Abstract
Aim: Surgical procedures in palliative care are common, however the indications, risks and outcomes are not well described. We present a retrospective review of the management of cancer patients. Material and Methods: During the period 2000-2022, 11.700 of cancer cases (abdominal, gynecological, urological and breast) were recorded in our registries and are analyzed. Group A: All 6000 patients (51,3%) included in this group had a therapeutic intent in their management which include surgical procedures ± neoadjuvant and systemic chemotherapy and radiotherapy. Group B: Palliative approach was applied in 2650 cases (22,6%) with both surgical and medical management being performed. Medical management consists of systemic chemotherapy and radiotherapy. Surgical procedures for palliation, include resections, reconstructions, ostomies, functional repairs, tube drainage and biopsies. Group C: Best supportive care was applied in 3050 cases (26,1%) which includes nutritional management with home parenteral or enteral nutrition, pain management, physical and respiratory physiotherapy, and fistulas or ulcers management. Primary end points include survival advantages while Quality of Life (QOL) was set as a secondary benefit. The risk of morbidity and treatment related mortality are also calculated between the different groups. Results: A median follow up of 80 months was observed. The median O.S. for group A was 44,4 ± 16,3 months and for palliative care group (B) was 26,3+11,7 m (p<0,01). On the other hand, the median O.S. for the group C (Best supportive care) was 8,7 ± 5,2 m. More specifically the group of patients with peritoneal metastasis which include 5200 patients (44,5%) of the total cancer patients was subdivided in 4 subgroups. The role of palliative surgery with or without systemic or neoadjuvant chemotherapy, offer a better O.S. when compared with only systemic chemotherapy (13,4 ± 7,5 m vs 71 ± 4,3 m) with acceptable morbidity and mortality rates. Conclusion: In conclusion, the need for holistic palliative care in cases of incurable malignancy is not entirely clear how it is best to integrate into palliative surgical principles. The essential roles of surgical palliation are, initial evaluation of the disease, local control, control of discharge or hemorrhage, control of pain and reconstruction and rehabilitation.
Authors and Affiliations
Spiliotis J1,2,3* , Rogdakis A4 , Kopanakis N3 , Noskova I2 , Metaxas T1 , Farmakis D1 , Vaikos D1 , Vaxevanidou A4 , Christopoulou A5 , Margari H2 , Saroyan H1 , Karachalios D1 , Peppas G2
Keywords
Related Articles
- EP ID EP713266
- DOI https://doi.org/10.46889/JCMR..2023.4103
- Views 51
- Downloads 0
Radiological and Functional Outcome of Internal Fixation of Monteggia Fracture Dislocation by DCP in Adult Patients
Background: Surgical reduction and internal fixation are the mainstays for the treatment of the Monteggia fracture-dislocation in adult and there are various surgical modalities for internal fixation. Various types of im...
Molecular Diagnosis of Resistant Tuberculosis Against Rifampicin to the Patients of the Centre Hospitalier Universitaire de Référence Nationale (CHU-RN): Preliminary Study During the COVID-19 Pandemic Period in N’Djamena, Chad
Background: The fight against Tuberculosis (TB) remains a challenging public health problem worldwide. Nowadays, resistance forms increase sharply in developed countries. With a rifampicin resistance rate of 7.2% higher...
MR Imaging in Unilateral Hydrocephalus in Adults
We present a case of a 19-year-old male who presented with history of headache and seizures of 3 years duration. There was unilateral lateral ventricle hydrocephalous. One of the two lateral ventricles was dilated. Idi...
Assessment of Renal Function Tests and Serum Total Protein among Pregnant Women with Pregnancy-Induced Hypertension Attending in Asrade Zewudie Memorable Hospital (ASZMPH), Gojjam, Ethiopia: Case-Control Study
Background: Pregnancy-induced hypertension has remained a significant global public health threat in both developed and developing countries. Therefore, this study aimed to assess renal function tests and serum total p...
Somatic Comorbidities among Senior Schizophrenics: A Local Pilot Estimation
Introduction: Comorbidity between mental disorders and physical illnesses is the rule rather than the exception. Approaches to study the impact of comorbidity become challenging also due to lack of consensus about how...